Journal of aerosol medicine and pulmonary drug delivery
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J Aerosol Med Pulm Drug Deliv · Feb 2013
ReviewAir pollution during pregnancy and neonatal outcome: a review.
There is increasing evidence of the adverse impact of prenatal exposure to air pollution. This is of particular interest, as exposure during pregnancy--a crucial time span of important biological development--may have long-term implications. The aims of this review are to show current epidemiological evidence of known effects of prenatal exposure to air pollution and present possible mechanisms behind this process. ⋯ So-called "tracking" of somatic growth and lung function is believed to have a huge impact on long-term morbidity, especially from a public health perspective. This is particularly important in areas with high levels of outdoor pollution, where it is practically impossible for an individual to avoid exposure. Especially in these areas, good evidence for the association between prenatal exposure to air pollution and infant mortality exists, clearly indicating the need for more stringent measures to reduce exposure to air pollution.
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J Aerosol Med Pulm Drug Deliv · Feb 2013
ReviewLung physiology and aerosol deposition imaged with positron emission tomography.
Physiological conditions and pathophysiological changes in the lungs may affect many applications in aerosol medicine and pulmonary drug delivery. In the diseased lung, spatial heterogeneity in function and structure may cause substantial changes in aerosol transport and local deposition among different lung regions. Non-uniform aerosol deposition affects airway or tissue pharmacological dosing, which could reduce the therapeutic effectiveness of inhalation therapy. ⋯ These examples demonstrate that it is possible to access both preexisting conditions, such as heterogeneity of ventilation, perfusion, and/or inflammatory stimuli, which may affect inhalation therapy, and the functional effects of inhaled medications or inflammatory agents on lung regional function. The imaging techniques described could be efficient tools to evaluate quantitatively and noninvasively these processes in vivo. Furthermore, it can be expected that imaging of respiratory structure and function will yield sensitive biomarkers of disease, which will help and speed drug discovery, and the evaluation of novel inhalation therapies.
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J Aerosol Med Pulm Drug Deliv · Dec 2012
New nebulizer technology to monitor adherence and nebulizer performance in cystic fibrosis.
Topical delivery of aerosolized therapies is an established treatment for chronic airway infection and inflammation in cystic fibrosis (CF). Recent developments in nebuliser technology have enabled Adaptive Aerosol Delivery (AAD) of mesh generated aerosol particles resulting in more efficient airway deposition than existing jet nebulizers. An additional feature of these new devices is the ability to record and examine the performance of the device by downloading stored data (electronic data capture). ⋯ This new breathing mode has also been evaluated in our pediatric CF clinic in a recent randomized controlled trial (RCT) and we have shown that children maintain adherence to treatment through the TIM mouthpiece and average treatment times reduced from 6.9 to 3.7 min when using TIM. This is a new era of aerosol delivery and novel advances in medical devices need to be monitored and assessed rigorously, particularly as new and potentially expensive therapies emerge from translational studies. Electronic data capture enables CF teams to work in an open partnership with patients to achieve the common goals of improving drug delivery and reducing patient burden.
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J Aerosol Med Pulm Drug Deliv · Dec 2012
Randomized Controlled Trial Comparative StudyDornase alpha compared to hypertonic saline for lung atelectasis in critically ill patients.
Despite the lack of randomized trials, nebulized Dornase alpha and hypertonic saline are used empirically to treat atelectasis in mechanically ventilated patients. Our objective was to determine the clinical and radiological efficacy of these medications as an adjunct to standard therapy in critically ill patients. ⋯ There was no significant improvement in the chest X-ray atelectasis score in mechanically ventilated patients with new onset atelectasis who were nebulized with Dornase alpha twice a day. Hypertonic saline was no more effective than normal saline in this population. Larger randomized control trials are needed to confirm our results.
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J Aerosol Med Pulm Drug Deliv · Oct 2012
Randomized Controlled TrialImaging the postdeposition dispersion of an inhaled surfactant aerosol.
Aerodynamic forces provide the primary means of distributing aerosol medications within the lungs. Partial airway obstructions can limit both air flow and aerosol penetration into diseased zones. We hypothesize that low surface tension additives may help to disperse aerosol medications after deposition in the airways, improving dose uniformity and drug delivery to underventilated regions. To test this, we performed a pilot scintigraphy study of surfactant and saline deposition and postdeposition dispersion. ⋯ Our results lack statistical significance, but suggest that inhaled calfactant increased peripheral clearance, due to either surfactant-based dispersion or mucociliary effects. Further studies are needed to define the potential for low surface tension carriers to improve drug delivery.